How women manage fatigue after childbirth

Postpartum stress in the first 6 months after delivery: a longitudinal study in Nantong, China

OBJECTIVES

The objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.

DESIGN

A longitudinal study with follow-ups from 42 days to 6 months after delivery.

SETTINGS AND PARTICIPANTS

A total of 406 postpartum women were recruited at baseline (42 days after delivery) from 6 hospitals in Nantong, Jiangsu Province, China, and followed up at 3 and 6 months. After the follow-ups, 358 postpartum women were retained for further analysis.

METHODS

Postpartum stress was evaluated using the Maternal Postpartum Stress Scale (MPSS) at baseline (42 days) and 3 and 6 months after delivery. MPSS has three dimensions, such as: personal needs and fatigue, infant nurturing and body changes and sexuality. Postpartum depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the short-form Depression, Anxiety and Stress Scale, respectively. The MPSS scores were normalised using a rank-based inverse normal transformation.

RESULTS

Postpartum stress decreased significantly after 3 months, and postpartum stress reduced further after 6 months. Additionally, the scores for all three dimensions reduced after 6 months, while infant nurturing reduced after both 3 and 6 months. Older age (β=0.028, p=0.049), higher education level (β=0.153, p=0.005) and higher body mass index (BMI) (β=0.027, p=0.008) of the postpartum women were significantly associated with higher postpartum stress levels in corresponding dimensions at 42 days. Older age was also associated with higher postpartum stress at 3 (β=0.030, p=0.033) and 6 months (β=0.050, p<0.001) in the dimension of personal needs and fatigue. Postpartum stress levels were significantly higher in women with depression or anxiety symptoms.

CONCLUSIONS

Postpartum stress continuously declined from 42 days to 6 months after delivery. Postpartum women with older age, higher education levels, higher BMI and anxiety or depression symptoms should be the target population for early intervention.

Residential parenting services: An integrative literature review of characteristics, service usage and parent and staff perspectives

AIMS

The primary aim of the review was to provide an overall assessment of residential parenting services in Australia, by describing the characteristics of infants and parents using residential parenting services, their prior service use and reasons for admission, referral pathways for access and parenting and infant outcomes. The secondary aims were to explore parent and staff perception of the programmes.

DESIGN

An integrative literature review.

METHODS

A systematic and comprehensive search of health and social sciences databases was conducted for studies related to residential parenting services (published between 1st January 1990-31st December 2019). Six hundred and eleven peer-reviewed papers were identified, after which 301 duplicates were removed and an additional 256 papers excluded after titles/abstracts were read. Of the remaining 54 abstracts/papers, a further 14 were omitted as not relevant. Forty papers were independently reviewed by four authors. ENTREQ and MOOSE checklists were applied.

RESULTS

Thirty studies were quantitative, nine were qualitative, and one was mixed methods. All studies originated from in Australia. Women and babies admitted to residential parenting services were found more likely to be: older, Australian born, from higher socio-economic groups, and first-time mothers, and having labour and birth interventions and a history of mental health disorders. The babies were more likely to be twins, male and admitted with sleep disorders and dysregulated behaviour. Studies reporting postintervention outcomes demonstrated improvements to maternal mental health, breastfeeding, parenting confidence and sleep quality, and infant sleeping and behaviour.

Trajectory patterns and factors influencing perinatal fatigue among Chinese women from late pregnancy to 6 months after delivery

Background

Perinatal fatigue among women is related to the clinical outcomes of mothers and infants. Perinatal fatigue changes over time, and the trajectory varies according to the predictors and outcomes of the mothers. This, however, has not been documented in any study.

Objectives

This study aimed to identify and characterize the trajectory patterns of perinatal fatigue among women from late pregnancy to 6 months after delivery.

Methods

We used growth mixture modeling to estimate the trajectory of perinatal fatigue at 28 gestational weeks (T0), 37 gestational weeks (T1), 3 days (T2), 1 week (T3), 6 weeks (T4), and 6 months (T5) after delivery with (n = 1,030). The Mann-Whitney U test and binary logistic regression were used to tie the selected trajectory classes to predictors and outcomes.

Results

There were two distinct patterns of perinatal fatigue in women: "persistently high" (11.1%, n = 114) and "persistently low" (88.9%, n = 916). Levels of perinatal fatigue among women in the "persistently high" group were higher than those in the "persistently low" group across the six measurements. Complications, fatigue at T0, and employment status in late pregnancy were all significant predictors of trajectories. Additionally, the "persistently high" group had a greater prevalence of difficult baby care and weight retention and a lower prevalence of exclusive breastfeeding.

Conclusions

Our study proved the heterogeneity and characteristics of perinatal fatigue among women. Future research should concentrate on developing intervention packages targeted at specific individuals in order to alleviate perinatal fatigue in women.

Mothers’ strategies for creating positive breastfeeding experiences: a critical incident study from Northern Sweden

Background

Positive breastfeeding experiences positively influence subsequent attitudes towards breastfeeding, and increase mothers’ confidence, self-efficacy, motivation and intention to breastfeed. However, the strategies that mothers find useful and effective for creating positive breastfeeding experiences remain largely unknown. The aim of our study was thus to describe experience-based knowledge from mothers about strategies for creating positive breastfeeding experiences.

Methods

The study followed a qualitative design involving the critical incident technique. Data were collected with an online survey containing open-ended questions that was administered to a Sweden-based parenting group on Facebook in September 2018. Ultimately, 340 incidents from 176 women were identified as offering strategies for creating positive breastfeeding experiences. Data from the written replies were extracted as textual units, condensed and categorised until categories were mutually exclusive, which resulted in six categories.

Results

Participating women were on average 31.2 years old and the median number of children per participant was two. Mothers’ strategies for creating positive breastfeeding experiences generally included being calm and accepting that initiating breastfeeding takes time and can be difficult initially. Participants described feeling close to the baby by maintaining skin-to-skin contact and being present in the moment by taking time to appreciate the child and the breastfeeding situation, and temporarily forgetting about the world and simply being with the child in the here and now. Participants advocated baby-led breastfeeding and following correct techniques. They also described the importance of keeping an effortless mindset about breastfeeding to prevent perceiving breastfeeding as a compulsion. Mothers described acquiring knowledge about breastfeeding so that they could be prepared if breastfeeding problems occurred and getting support from professionals and family was described as significant for having a positive breastfeeding experience. Caring for oneself and one’s body, with aids if necessary, were described as important strategies, as were having a positive attitude and a strong desire to breastfeed.

Conclusion

Because positive breastfeeding experiences and support are predictors of future breastfeeding initiation and duration, assisting women in creating positive breastfeeding experiences is important. Asking mothers to formulate strategies that they find useful could facilitate breastfeeding by making their approaches more conscious and visible.

A Quantile Regression Analysis of Factors Associated with First-Time Maternal Fatigue in Korea

The aim of this cross-sectional study was to identify the factors associated with different percentiles of first-time maternal fatigue. A total of 123 first-time healthy mothers aged 18 years or older participated through an online survey. The fatigue was measured by the Korean version of the fatigue severity scale. Main variables were constructed based on the integrated fatigue model, which included mothers' sleep quality, parenting stress, the amount of free time mothers have, the number of the child's night wakings, general characteristics including socioeconomic status, and working status. Quantile regression was used to analyze the associated factors according to the fatigue level of first-time mothers with a young child. The mean age of the mothers and children were 32.11 years and 20.81 months, respectively. Mean fatigue score was 6.16 among the 75% quantile with high fatigue score. Lack of adequate free time in mothers, advanced maternal age, being a housewife, having a moderate income, and frequent night wakings of their child significantly increased fatigue among mothers in the third quantile of fatigue. To reduce fatigue, healthcare providers should focus on exploring ways to reduce maternal sleep disturbance and improve maternal sleep quality.

Relationship between prenatal and maternal attachment: a longitudinal study from Turkey

The healthy development of the attachment which starts in the prenatal period and continues after the birth strengthens, positively supports the newborn care and contributes to raising healthy individuals in the future. This study was carried out to determine the effect of mother-fetus attachment that develops during pregnancy on mother-infant attachment in the postpartum period. This descriptive, correlational and longitudinal study was conducted with 150 volunteer mothers who could be reached again within 1-4 months after birth. Data were collected by the Questionnaire Form, the Prenatal Attachment Inventory (PAI) and the Maternal Attachment Scale (MAS). When the relationship between participants' PAI (41.20 ± 11.35) and MAS (26.05 ± 5.13) point averages was examined, it was observed that there was a weak, positive and statistically significant relationship between the two scales (r = 0.304, p=.000). It was observed that there was a relationship between the attachment between pregnant woman and developing fetus and the maternal attachment in the postnatal period.Impact statementWhat is already known on this subject? Attachment is a process which is formed by an interaction between the mother and the infant that is satisfying and enjoyed by both sides. It provides a basis for the establishment of relationships of the infant with the outside world and for the psychological development of the infant.What the results of this study add? This study has shown that a strong and healthy establishment of attachment in the prenatal period will positively contribute to the mother-infant attachment process in the postnatal period. A strong and healthy establishment of attachment in the prenatal period will positively contribute to the mother-infant attachment process in the postnatal period.What the implications are of these findings for clinical practice and/or further research? Mother-infant attachment can be strengthened just before the baby is born by determining the prenatal attachment and providing the appropriate approach to those who identify the problems in this regard, and thus, the risk of neglect and exploitation of the baby can be reduced and also the problems such as breastfeeding of the baby after birth, receiving proper care, and postnatal depression in the mother can even be reduced.

The influence of sleep quality on weight retention in the postpartum period

Poor sleep in the postpartum is often treated as an unavoidable consequence of childbirth. This study aims to compare objective and subjective measures of sleep, explore the relationship between sleep and postpartum weight retention (PPWR), and investigate factors that may contribute to sleep quality in the postpartum period. In this cross-sectional cohort, PPWR, sleep quality (Pittsburgh Sleep Quality Index (PSQI)), and objective sleep and physical activity (accelerometry) were assessed in 109 women 0–52 weeks postpartum. Anthropometric and demographic data were collected. Gestational weight gain (GWG) was classified as inadequate, appropriate, or excessive according to Institute of Medicine guidelines. Average GWG (33.7 lbs) and PPWR (5.39 lbs) were not different between “good” (PSQI < 6) and “bad” (PSQI ≥ 6) sleepers. Following adjustment, mothers with excessive GWG who were “bad” sleepers had 5.26 higher odds of PPWR ≥ 10 lbs compared with all other combinations of GWG and PSQI. PSQI was not correlated with total sleep time (accelerometer-derived). Light activity and moderate-to-vigorous physical activity (MVPA) were associated with reduced odds of being a “bad” sleeper. The influence of GWG on PPWR was modified by postpartum sleep quality. Both light activity and meeting the MVPA guidelines in the postpartum were associated with higher sleep quality.

Novelty Subjectively rated poor sleep may represent the number of awakenings and wake after sleep onset in postpartum women. Poor postpartum sleep quality increases excessive postpartum weight retention in women with excessive GWG. Women doing light-to-vigorous physical activity in the postpartum are less likely to experience poor sleep quality.

Using Levine's conservation model in postpartum care: a randomized controlled trial

This randomized controlled trial was conducted with 117 puerperae who were assigned into 2 groups: the intervention group and the control group. While the participants in the intervention group participated in a full program based on the module trainings, the participants in the control group received routine care. There was a significant difference between the women in the intervention and control groups in terms of the variables such as fatigue, sleep, and quality of life. The women in the intervention group experienced less fatigue, and their quality of sleep and quality of life improved considerably. Levine's conservation model enables the provision of the integrative care to women in their postpartum period.

Characteristics and changes in characteristics of women and babies admitted to residential parenting services in New South Wales, Australia in the first year following birth: a population-based data linkage study 2000-2012

OBJECTIVE

To examine the characteristics of women and babies admitted to the residential parenting services (RPS) of Tresillian and Karitane in the first year following birth.

DESIGN

A linked population data cohort study was undertaken for the years 2000-2012.

SETTING

New South Wales (NSW), Australia.

PARTICIPANTS

All women giving birth and babies born in NSW were compared with those admitted to RPS.

RESULTS

During the time period there were a total of 1 097 762 births (2000-2012) in NSW and 32 991 admissions to RPS. Women in cohort 1: (those admitted to RPS) were older at the time of birth, more likely to be admitted as a private patient at the time of birth, be born in Australia and be having their first baby compared with women in cohort 2 (those not admitted to an RPS). Women admitted to RPS experienced more birth intervention (induction, instrumental birth, caesarean section), had more multiple births and were more likely to have a male infant. Their babies were also more likely to be resuscitated and have experienced birth trauma to the scalp. Between 2000 and 2012 the average age of women in the RPS increased by nearly 2 years; their infants were older on admission and women were less likely to smoke. Over the time period there was a drop in the numbers of women admitted to RPS having a normal vaginal birth and an increase in women having an instrumental birth.

CONCLUSION

Women who access RPS in the first year after birth are more socially advantaged and have higher birth intervention than those who do not, due in part to higher numbers birthing in the private sector where intervention rates are high. The rise in women admitted to RPS (2000-2012) who have had instrumental births is intriguing as overall rates did not increase.

The Relationships among Postpartum Fatigue, Depressive Mood, Self-care Agency, and Self-care Action of First-time Mothers in Bangladesh

PURPOSE

Postpartum fatigue can impact maternal well-being and has been associated with levels of perceived self-care. This study aimed to examine the relationship among fatigue, depressive mood, self-care agency, and self-care action among postpartum women in Bangladesh.

METHODS

A descriptive cross sectional survey was done with 124 first-time mothers from two tertiary hospitals in Dhaka, Bangladesh. The Modified Fatigue Symptoms checklist, Denyes' Self Care Instrument, the Edinburgh Postnatal Depression Scale, and items on sociodemographic and delivery-related characteristics, were used in Bengali via translation and back-translation process.

RESULTS

High fatigue levels were found in 18.5%(n=23) and 73.4% had possible depression (n=91). There was a significant negative relationship between fatigue and self-care agency (r=-.31, p < .001), and self-care action (r=-.21, p < .05). Fatigue differed by level of self-care agency (t=4.06, p < .001), self-care action (t=2.36, p=.023), newborn's APGAR score (t=-2.93, p=.004), parental preparation class participation (F=15.53, p < .001), and postpartum depressive mood (t=-4.64, p < .001).

CONCLUSION

Findings suggest that high level of self-care efficacy and behaviors can contribute to fatigue management, and highlight the need for practical interventions to better prepare mothers for postpartum self-care, which may, in turn, alleviate postpartum fatigue.

Childbirth and parenting preparation in antenatal classes

OBJECTIVES

to describe topics (1) presented by midwives' during antenatal classes and the amount of time spent on these topics and (2) raised and discussed by first-time parents and the amount of time spent on these topics.

DESIGN

qualitative; data were gathered using video or tape recordings and analysed using a three-pronged content analysis approach, i.e., conventional, summative, and directed analyses.

SETTING AND PARTICIPANTS

3 antenatal courses in 2 antenatal units in a large Swedish city; 3 midwives; and 34 course participants.

FINDINGS

class content focused on childbirth preparation (67% of the entire antenatal course) and on parenting preparation (33%). Childbirth preparation facilitated parents' understanding of the childbirth process, birthing milieu, the partner's role, what could go wrong during delivery, and pain relief advantages and disadvantages. Parenting preparation enabled parents to (i) plan for those first moments with the newborn; (ii) care for/physically handle the infant; (iii) manage breastfeeding; (iv) manage the period at home immediately after childbirth; and (v) maintain their relationship. During the classes, parents expressed concerns about what could happened to newborns. Parents' questions to midwives and discussion topics among parents were evenly distributed between childbirth preparation (52%) and parenting preparation (48%).

KEY CONCLUSIONS

childbirth preparation and pain relief consumed 67% of course time. Parents particularly reflected on child issues, relationship, sex, and anxiety. Female and male participants actively listened to the midwives, appeared receptive to complex issues, and needed more time to ask questions. Parents appreciated the classes yet needed to more information for managing various post-childbirth situations.

IMPLICATIONS FOR PRACTICE

while midwifery services vary among hospitals, regions, and countries, midwives might equalise content focus, offer classes in the second trimester, provide more time for parents to talk to each other, allow time in the course plan for parents to bring up new topics, and investigate: (i) ways in which antenatal course development and planning can improve; (ii) measures for evaluating courses; (iii) facilitator training; and (iv) parent satisfaction surveys.

Effect of Lavender Oil Aroma in the Early Hours of Postpartum Period on Maternal Pains, Fatigue, and Mood: A Randomized Clinical Trial

BACKGROUND

Busy care providers focus on the serious complications of postpartum period. This issue causes the seemingly trivial complications, such as mother's pains, fatigue, and psychological status, to be less taken into account. The study aimed to determine the effect of lavender oil aroma in the early hours of postpartum period on maternal pains, fatigue, and mood in primiparous mothers.

METHODS

This randomized clinical trial was conducted on 56 participants; 29 in intervention group and 27 in control group. The intervention group received lavender oil in three doses during the first 24 h after delivery. Sesame oil was used in the control group. Intensity of pain, fatigue, and distress level was measured by visual analog scale before and after the interventions. Besides, mood status was assessed through the positive and negative affect schedule.

RESULTS

The mean age of all the participants was 23.88 ± 3.88 years. After the first intervention and also in the tomorrow morning assessment, significant differences were found between the two groups regarding perineal pain (P = 0.004, P < 0.001), physical pain (P < 0.001), fatigue (P = 0.02, P < 0.001), and distress scores (P < 0.001). In addition, significant differences were found concerning the mean scores of positive (P < 0.001) and negative (P = 0.007, P < 0.001) moods between the two groups after the interventions. Repeated measures analyses showed that the two groups were significantly different over time in all the evaluated variables.

CONCLUSIONS

Lavender oil aromatherapy starting in the first hours of postpartum period resulted in better physical and mood status compared to nonaromatic group.

The Role of Self-Care for Parents in Recovery From Substance Use Disorders: An Integrative Review of Parental Self-Care

BACKGROUND

Lack of stress modifiers, such as self-care behaviors (SCBs), can increase vulnerability to drug use for parents in recovery from substance use disorders (SUDs).

PURPOSE

The purpose of this integrative review was to determine how the existing literature describes, conceptualizes, and measures SCB for parents in the general population for its application to parents with a history of SUD.

METHODS

Framed by Bandura's Social Cognitive Theory of Substance Abuse, four qualitative and five quantitative studies identify SCB, although only one study describes SCB of parents in recovery.

RESULTS

Few studies addressed parental SCB, and most of those studies focused on behaviors for new mothers with or without SUDs during the early child years.

CONCLUSIONS

Exploring the role of SCB in relation to parental well-being for the general population is a needed area for further research, even more so for parents who are recovering from SUDs.

Effect of Pilates exercises on postpartum maternal fatigue

INTRODUCTION

Postpartum fatigue is a pervasive phenomenon and often affects mothers immediately after delivery. The present study aimed to assess the effect Pilates home exercises had on postpartum maternal fatigue.

METHODS

A total of 80 women participated in our clinical trial study. The women were randomly divided into two groups - the intervention group (n = 40) and the control group (n = 40). In the intervention group, the women performed Pilates exercises five times a week (30 min per session) for eight consecutive weeks. The first session was conducted 72 hours after delivery. The control group did not receive any intervention. Each woman's level of fatigue was evaluated at hospital discharge (as a baseline), and at four and eight weeks after delivery, using the standard Multidimensional Fatigue Inventory (MFI-20) questionnaire and repeated measures analysis.

RESULTS

During the eight weeks of follow-up, we found that the intervention group had lower mean MFI-20 scores than the control group with regard to general fatigue (7.80 ± 2.07 vs. 12.72 ± 1.79; p < 0.001), physical fatigue (7.12 ± 1.41 vs. 10.42 ± 2.02; p < 0.001), reduced activity (6.95 ± 1.35 vs. 11.27 ± 1.70; p < 0.001), reduced motivation (6.20 ± 1.01 vs. 9.80 ± 2.04; p < 0.001) and mental fatigue (6.85 ± 1.45 vs. 10.72 ± 1.98; p < 0.001).

CONCLUSION

The present study's findings show that physical exercise can significantly reduce postpartum maternal fatigue in all subscales.

Depressive symptoms and changes in physiological and social factors 1 week to 4 months postpartum in Japan

BACKGROUND

Postpartum depression (PPD) is a common condition and may be exacerbated unless treated. There is, however, a lack of longitudinal studies about the relationship between PPD and changes in physiological status and social role postpartum.

METHODS

We enrolled longitudinally 65 Japanese mothers (36 primiparas) and measured their psychological responses at 1 week, 1 month, and 4 months postpartum. The physiological indicators were three urine catecholamine fraction levels, cortisol levels, and heart-rate variability. We used the Edinburgh Postnatal Depression Scale (EPDS) and 28-item General Health Questionnaire (GHQ) for psychological evaluation.

RESULTS

Eleven participants had an EPDS score ≥9 (cutoff point) at 1 month and five at 4 months. With GHQ total score, 32 participants had ≥6 (cutoff point) at 1 month and 17 at 4 months. The psychological indicators underwent change from childbirth to 4 months postpartum. However, there was no correlation between the psychological and physiological indicators. We likewise found EPDS and GHQ scores were not influenced by parity or undertaking of social activities.

LIMITATIONS

The mothers׳ high education level may mean that the results are not generalizable to Japan overall. We were unable to evaluate the status of 11 mothers who dropped out. The participants may have lacked sufficient time to complete questionnaires, resulting in diminished accuracy. We could not determine the prevalence of PPD.

CONCLUSIONS

Irrespective of parity status, postpartum mothers showed physiological and mental changes caused by childrearing-related stress. To prevent PPD, postnatal mothers need continuous screening with appropriate evaluating indicators and individualized advice.

Mothers' strategies in handling the prematurely born infant: a qualitative study

INTRODUCTION

Family, especially mother, is faced with numerous challenges by experiencing a premature birth. Since knowing about mother's efforts regarding prematurely born infant helps us in our comprehensive understanding of the impact of this incident on the family system and its performance. The present study was carried out to explore the mothers' strategies regarding prematurely born infant.

METHODS

In a conventional qualitative content analysis, data was collected through purposive sampling by semi-structured deep interviews with 18 mothers who had prematurely born infant during 2012-2013 in the teaching hospitals of the north and northwest of Iran. All the interviews were recorded, typed, and finally analyzed.

RESULTS

Data analysis resulted in the extraction of categories of "asking for help, elevating capacity and reducing personal responsibilities and commitments". These categories were revealed in mothers respectively by the different sub-categories of "religious appeal and relying on beliefs, seeking information from the treatment and caring team, participating in infant's care, companionship and support of family and friends","focusing on positive thinking and imagination, patience and strength " and "ignoring some routine affairs and reducing role-related activities and duties".

CONCLUSION

Considering the uniqueness of the mother's role in responding to the needs of infants, healthcare system should consider mothers as real target in the intervention strategies in order to promote health and quality of life, so maybe this way, the burden of care and management of critical situations caused by a premature birth on the mother can be reduced.

Predictive factors of postpartum fatigue: a prospective cohort study among working women

OBJECTIVES

The aim of this study was to investigate which prepartum determinants contribute to the development of postpartum (PP) fatigue among working women in the Netherlands.

METHODS

A prospective cohort study in 15 Dutch companies was conducted to measure different potential predictors using self-administrated questionnaires at baseline and at 30 weeks of pregnancy. Fatigue was measured at 12 (N=523) and 52 weeks (N=436) PP using the Checklist Individual Strength (CIS). A CIS score>76 was defined as fatigue.

RESULTS

The prevalence of fatigue at 12 and 52 weeks PP was 24.5% and 18.1%, respectively. Fourteen predictive factors were found for fatigue (R(2)=0.37) at 12 weeks PP. Ten predictive factors were found for fatigue at 52 weeks PP (R(2)=0.36). In general, less favourable work relationships and characteristics, poorer mental health, more passive coping styles, more sleeping problems, more fatigue during pregnancy, and beliefs about child care arrangements were related to PP fatigue. At 30 weeks of pregnancy, only more fatigue (OR=3.69, p<0.001; OR=2.68, p=0.02) and poorer mental health (OR=0.50, p=0.02; OR=0.90, p=0.78) predicted fatigue both at 12 and 52 weeks PP.

CONCLUSIONS

A large number of predictive factors for PP fatigue were found. These findings indicate that different aspects can contribute to being fatigued after pregnancy. Further research is needed to investigate the effect of possible interventions by employers and/or occupational physicians.

Maternal accounts of their breast-feeding intent and early challenges after caesarean childbirth

BACKGROUND

breast-feeding outcomes are often worse after caesarean section compared to vaginal childbirth.

OBJECTIVES

this study characterises mothers' breast-feeding intentions and their infant feeding experiences after caesarean childbirth.

METHODS

data are from 115 mothers on a postnatal unit in Northeast England during February 2006-March 2009. Interviews were conducted an average of 1.5 days (range 1-6 days) after the women underwent unscheduled or scheduled caesarean.

RESULTS

thematic analysis of the data suggested was mostly considered the 'right thing to do,' preferable, natural, and 'supposedly healthier,' but tiring and painful. Advantages of supplementation involved more satiated infants, feeding ease, and longer sleep bouts. The need for 'thinking about yourself' was part of caesarean recovery. Infrequent feeding was concerning but also enabled maternal rest. Other breast-feeding obstacles were maternal mobility limitations, positioning difficulties, and frustration at the need for assistance. Participants were confused about nocturnal infant wakings, leading many to determine that they had insufficient milk. Mothers were surprised that sub-clinically poor infant condition was common following caesarean section. Some breast-feeding difficulty stemmed from 'mucus' expulsion that had to occur before the infants could be 'interested' in feeding. Women who cited motivations for breast feeding that included benefit to themselves were more likely to exclusively breast feed on the postnatal unit after their caesareans than those who reported infant-only motivations.

CONCLUSIONS

for the majority of mothers, breast feeding after a caesarean is affected by interrelated and compounding difficulties. Provision of more relational breast-feeding information may enable families to better anticipate early feeding experiences after caesarean section childbirth.

Online resources for new mothers: opportunities and challenges for perinatal health professionals

Studies have shown increasing Internet use for health information and service facilities. After consulting a convenience sample of new mothers, this study applied select terms and phrases to a widely accepted search engine and investigated its potential for providing resources for new mothers. Results of this quantitative content analysis showed that only four of the 13 phrases used in the search generated 50% or more websites containing content relevant to new mothers. Findings indicate that informational support by way of electronic fact sheets is available using the Google search engine. However, functional support (e.g., social networks, consultation phone details, and mother-infant activities) configured limited data resources using the Google search engine. In addition, because websites can be difficult to navigate, users' technical proficiency needs to be taken into consideration as well as the sites' up-to-date information. With Internet technology rapidly expanding, perinatal educators and other perinatal health-care professionals need to be informed about current online resources to help direct consumers to useful online resources and mitigate the often overwhelming and confusing information.

Wide Awake Parenting: study protocol for a randomised controlled trial of a parenting program for the management of post-partum fatigue

BACKGROUND

Exhaustion and fatigue are commonly experienced by parents during the post-partum period, and can have implications for daily functioning, mental health and parenting practices. There is a need for the development of effective interventions to assist parents with the management of fatigue. This paper outlines the procedure for a randomised controlled study which aims to test the efficacy of Wide Awake Parenting, a program for the management of fatigue in the postnatal period.

METHODS/DESIGN

Parents with an infant less than 6 months of age, and from seven Local Government Areas in Melbourne, Australia were invited to participate in this study. Parents were randomised to receive the Wide Awake Parenting program (intervention groups) or usual care (control group) offered by health services. The Wide Awake Parenting program provides parents with psycho-education and information about fatigue, and strategies to reduce its effects either via a self-directed method, or professionally led with a home visit and telephone support. Baseline data will be collected prior to randomisation, and further data will be collected at 2- and 6-weeks post intervention.

DISCUSSION

To our knowledge this is the first randomised controlled trial of a program which compares the efficacy of a self-management approach and health professional assistance for the management of fatigue in the early post-partum period. If effective, it could offer an important, universal public health management approach to this common health concern.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry, ACTRN12611000133932.

Empirical test of an explanatory theory of postpartum fatigue in Korea

AIM

This paper is a report of a study designed to test an explanatory theory of postpartum fatigue.

BACKGROUND

Postpartum fatigue is influenced by various factors and affects a mother's performance. A full understanding of postpartum fatigue is very important for developing effective nursing strategies to reduce postpartum fatigue and enhance mothers' performance.

METHODS

Healthy postpartum women were recruited from five medical centers and one midwifery office in urban area in Korea (n = 291) by convenience sampling. Data were collected at 4- to 8-week follow-up visits after childbirth in 2006, using a self-report questionnaire. The proposed fatigue theory incorporated postpartum fatigue, postpartum depression, sleep quality, childcare stress, unsatisfactory feeding, social support, infant difficulty and satisfaction with Sanhujori, the Korean traditional postpartum care provided for 3 weeks following delivery by non-professional caregivers. Structural equation modelling was used to test the explanatory theory of postpartum fatigue.

RESULTS

The modified fatigue theory showed good fit and high compatibility with the empirical data. In the final explanatory theory, postpartum depression and sleep quality directly affected postpartum fatigue, while childcare stress and the cultural phenomenon of Sanhujori had indirect effects on postpartum fatigue, via postpartum depression and sleep quality respectively.

CONCLUSION

These findings suggest the potential role of comprehensive nursing focused on decreasing postpartum depression and improving sleep quality as a way to decrease postpartum fatigue. Also, nursing strategies for decreasing childcare stress and enhancing Sanhujori satisfaction may be helpful in reducing postpartum fatigue in Korean mothers.

Joy, struggle and support: postpartum experiences of first-time mothers in a Tanzanian suburb

OBJECTIVES

To explore and describe postpartum experiences of first-time mothers in a Tanzanian, multiethnic, low-income suburb.

METHODS

Individual qualitative interviews with 10 first-time mothers, 4-10 weeks postpartum in Ilala suburb, Dar es Salaam, Tanzania.

RESULTS

The first-time mothers enjoyed motherhood and the respectful status it implied. To understand and handle the infant's needs and own bodily changes were important during postpartum. The tradition of abstaining from sex up to 4 years during breastfeeding was a concern as male's faithfulness was questioned and with HIV a threat to family health. Partner relationship changed towards shared parental and household work and the man's active participation was appreciated. Support from family members and others in the neighbourhood were utilised as a resource by the mothers. In instances of uncertainties on how to handle things, their advice was typically followed. The new mothers generally had good experiences of health care during the childbearing period. However, they also experienced insufficiencies in knowledge transfer, disrespectful behaviour, and unofficial fees. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: The mothers' perspective of postpartum revealed that they actively searched for ways to attain infants' and own health needs, and family health in general. Prolonged sexual abstinence was considered a risk for the partner having other sexual partners and contracting HIV. The mothers relied heavily on the informal support network, which sometimes meant risking family health due to misinformation and harmful practices. Health care and informal support systems should complement each other to attain adequate support for the families postpartum.

Crying babies, tired mothers - challenges of the postnatal hospital stay: an interpretive phenomenological study

Background

According to an old Swiss proverb, "a new mother lazing in childbed is a blessing to her family". Today mothers rarely enjoy restful days after birth, but enter directly into the challenge of combining baby- and self-care. They often face a combination of infant crying and personal tiredness. Yet, routine postnatal care often lacks effective strategies to alleviate these challenges which can adversely affect family health. We explored how new mothers experience and handle postnatal infant crying and their own tiredness in the context of changing hospital care practices in Switzerland.

Methods

Purposeful sampling was used to enroll 15 mothers of diverse parity and educational backgrounds, all of who had given birth to a full term healthy neonate. Using interpretive phenomenology, we analyzed interview and participant observation data collected during the postnatal hospital stay and at 6 and 12 weeks post birth. This paper reports on the postnatal hospital experience.

Results

Women's personal beliefs about beneficial childcare practices shaped how they cared for their newborn's and their own needs during the early postnatal period in the hospital. These beliefs ranged from an infant-centered approach focused on the infant's development of a basic sense of trust to an approach that balanced the infants' demands with the mother's personal needs. Getting adequate rest was particularly difficult for mothers striving to provide infant-centered care for an unsettled neonate. These mothers suffered from sleep deprivation and severe tiredness unless they were able to leave the baby with health professionals for several hours during the night.

Conclusion

New mothers often need permission to attend to their own needs, as well as practical support with childcare to recover from birth especially when neonates are fussy. To strengthen family health from the earliest stage, postnatal care should establish conditions which enable new mothers to balance the care of their infant with their own needs.